Fear facilitates utilitarian moral judgments: Evidence from a moral judgment task

Previous research on moral judgment (MJ) has focused on understanding the cognitive processes and emotional factors that influence different types of moral judgment tasks, such as personal and impersonal dilemmas. However, few studies have distinguished between the emotions related to cognition and the complex emotions specifically caused by MJ tasks. This gap in knowledge is important to address to have a better understanding of how emotions influence moral judgment. The aim of this study was to investigate the influence of fear and the role of moral emotions on MJ. Data were collected from 145 participants through jsPsych and analyzed using mixed-model analysis of variance (ANOVA) and correlation analysis. The study found that individuals who were triggered by the fear increased the number of utilitarian moral judgments in personal moral scenarios and lengthened the cognitive process, but not in impersonal moral dilemmas. Hence, we speculate that fear may play a cognitive role in personal moral dilemmas and an emotional role in impersonal moral dilemmas. Another finding is that the complex moral emotions arising from the moral decision-making process may affect the effectiveness of fear and potentially influence moral judgments. However, this study adopts a cautious attitude toward these discoveries, and further verification of this hypothesis should be conducted in the future.

Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study

(1) Background: The COVID-19 pandemic has led to an increase in the complexity of caregiving, resulting in challenging situations for perioperative nurses. These situations have prompted nurses to assess their personal and professional lives. The aim of this study was to explore the experiences of perioperative nurses during the first wave of the COVID-19 pandemic, with a specific focus on analyzing moral breakdowns and ethical dilemmas triggered by this situation. (2) Methods: A qualitative design guided by a hermeneutical approach was employed. Semi-structured interviews were conducted with 24 perioperative nurses. The interviews were transcribed and thematically analysed following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. (3) Results: The findings revealed three main categories and ten subcategories. These categories included the context in which moral breakdowns emerged, the ethical dilemmas triggered by these breakdowns, and the consequences of facing these dilemmas. (4) Conclusions: During the first wave of COVID-19, perioperative nurses encountered moral and ethical challenges, referred to as moral breakdowns, in critical settings. These challenges presented significant obstacles and negatively impacted professional responsibility and well-being. Future studies should focus on identifying ethical dilemmas during critical periods and developing strategies to enhance collaboration among colleagues and provide comprehensive support.

The Drunk Utilitarian Revisited: Does Alcohol Really Increase Utilitarianism in Moral Judgment?

The "drunk utilitarian" phenomenon suggests that people are more likely to accept harm for the greater good when they are under the influence of alcohol. This phenomenon conflicts with the ideas that (a) acceptance of pro-sacrificial harm requires inhibitory control of automatic emotional responses to the idea of causing harm and (b) alcohol impairs inhibitory control. This preregistered experiment aimed to provide deeper insights into the effects of alcohol on moral judgments by using a formal modeling approach to disentangle three factors in moral dilemma judgments and by distinguishing between instrumental harm and impartial beneficence as two distinct dimensions of utilitarian psychology. Despite the use of a substantially larger sample and higher doses of alcohol compared with the ones in prior studies, alcohol had no significant effect on moral judgments. The results pose a challenge to the idea that alcohol increases utilitarianism in moral judgments.

A moral trade-off system produces intuitive judgments that are rational and coherent and strike a balance between conflicting moral values

How does the mind make moral judgments when the only way to satisfy one moral value is to neglect another? Moral dilemmas posed a recurrent adaptive problem for ancestral hominins, whose cooperative social life created multiple responsibilities to others. For many dilemmas, striking a balance between two conflicting values (a compromise judgment) would have promoted fitness better than neglecting one value to fully satisfy the other (an extreme judgment). We propose that natural selection favored the evolution of a cognitive system designed for making trade-offs between conflicting moral values. Its nonconscious computations respond to dilemmas by constructing "rightness functions": temporary representations specific to the situation at hand. A rightness function represents, in compact form, an ordering of all the solutions that the mind can conceive of (whether feasible or not) in terms of moral rightness. An optimizing algorithm selects, among the feasible solutions, one with the highest level of rightness. The moral trade-off system hypothesis makes various novel predictions: People make compromise judgments, judgments respond to incentives, judgments respect the axioms of rational choice, and judgments respond coherently to morally relevant variables (such as willingness, fairness, and reciprocity). We successfully tested these predictions using a new trolley-like dilemma. This dilemma has two original features: It admits both extreme and compromise judgments, and it allows incentives-in this case, the human cost of saving lives-to be varied systematically. No other existing model predicts the experimental results, which contradict an influential dual-process model.

How German and Italian Laypeople Reason about Distributive Shortages during COVID-19

(1) Background: The COVID-19 pandemic provided a unique opportunity to investigate how moral reasoning is influenced by individuals' exposure to a crisis and by personal, societal and temporal proximity. We examined how Italians and Germans judged different behaviors that arose because of the pandemic, which affected health and societal matters. (2) Methods: Over the course of four months and three assessment periods, we used an observational online survey to assess participants' judgments regarding seven scenarios that addressed distributive shortages during the pandemic. (3) Results: Overall, there was no clear answering pattern across all scenarios. For a variation of triage and pandemic restrictions, most participants selected a mean value, which can be interpreted as deferring the choice. For the other scenarios, most participants used the extremes of the scale, thereby reflecting a clear opinion of the public regarding the moral issue. In addition, moral reasoning varied across the two countries, assessment periods, fear, and age. (4) Conclusions: By using scenarios that were taken from real-life experiences, the current study addresses criticism that moral research mostly relies on unrealistic scenarios that lack in external validity, plausibility, and proximity to everyday situations. In addition, it shows how lay people regard measures of public health and societal decision-making.

A Study of Common Principles for Decision-Making in Moral Dilemmas for Autonomous Vehicles

How decisions are made when autonomous vehicles (AVs) are faced with moral dilemmas is still a challenge. For this problem, this paper proposed the concept of common principles, which were drawn from the general public choice and could be generally accepted by society. This study established five moral dilemma scenarios with variables including the number of sacrifices, passenger status, presence of children, decision-making power subjects, and laws. Based on existing questionnaire data, we used gray correlation analysis to analyze the influence of the individual and psychological factors of participants in decision-making. Then, an independent sample t-test and analysis of covariance were selected to analyze the influence relationship between individual and psychological factors. Finally, by induction statistics of decision choices and related parameters of participants, we obtain common principles of autonomous vehicles, including the principle of protecting law-abiding people, the principle of protecting the majority, and the principle of protecting children. The principles have different priorities in different scenarios and can meet the complex changes in moral dilemmas. This study can alleviate the contradiction between utilitarianism and deontology, the conflict between public needs and individualized needs, and it can provide a code of conduct for ethical decision-making in future autonomous vehicles.

Awareness to utilitarian responses in later life: an ERP study with moral dilemmas

The current study aims to provide the first insights into the neural correlates of utilitarian and deontological responses to moral dilemmas across the lifespan.To this purpose, younger (n=30), middle-aged (n=29), and older adults (n=29) completed moral dilemmas during an EEG recording.Behaviorally, groups did not differ in the number of utilitarian responses and reaction times. However, at the neural level, older adults had higher Error Positivity (Pe) amplitudes than younger adults after utilitarian responses.As this effect was specific to utilitarian responses, it suggests that utilitarian decisions may induce increased conflict in the older group. These findings highlight that older adults may be more aware of the harmful outcomes of utilitarian decisions during moral decision-making.

Moral Injury and Recovery in Uniformed Professionals: Lessons From Conversations Among International Students and Experts

Introduction

In the course of service, military members, leaders, and uniformed professionals are at risk of exposure to potentially morally injurious events (PMIEs). Serious mental health consequences including Moral Injury (MI) and Post-traumatic stress disorder (PTSD) can result. Guilt, shame, spiritual/existential conflict, and loss of trust are described as core symptoms of MI. These can overlap with anxiety, anger, re-experiencing, self-harm, and social problems commonly seen in PTSD. The experiences of General (retired) Romeo Dallaire and other international experts who have led in times of crisis can help us better understand MI and recovery.

Objectives

In honor of Dallaire, online opportunities were created for international students and leaders/experts to discuss topics of MI, stigma, and moral codes in times of adversity as well as the moral impact of war. We aimed to (1) better understand MI and moral dilemmas, and (2) identify key insights that could inform prevention of and recovery from MI.

Materials and Methods

Webinars and conversations of 75-90 min duration on MI and recovery were facilitated by Leiden University, the University of Alberta and the Dallaire Institute for Children, Peace and Security between General Dallaire, world experts, and graduate students. Sessions were recorded, transcribed and thematically analyzed with NVivo using standard qualitative methodology.

Results

Ninety four participants engaged in conversations. Student engagements were attended by participants [N = 51; female (29), male (22)] from the Netherlands and Canada. Conversations were held with international experts [N = 43; female (19) and male (24)] from North America, Europe, Australia and the global south. Themes included: (1) recognizing the impact of exposure to PMIEs, (2) reducing stigma around MI, and (3) embracing the spiritual depth of humanity.

Conclusion

Exposure to PMIEs can have devastating impacts on military members, leaders and other uniformed professionals. This may lead to development of MI and PTSD. Recognizing MI as honorable may reduce stigma and psychological harm, and facilitate help-seeking among uniformed personnel and other trauma-affected populations. Salient efforts to address MI must include use of accurate measurements of MI and integrated holistic therapeutic approaches, inclusive of spiritual and social components. Urgency remains regarding the prediction, identification and treatment of MI.

Ambivalence and moral dilemmas in women's lived experiences of obesity and pregnancy: Qualitative insights for maternal lifestyle interventions

BACKGROUND

Maternal obesity is a global health concern that is associated with significant effects on both short- and long-term health of both mother and child. However, maternal lifestyle interventions tend to focus solely on diet and physical activity in ways that disembody and disengage the social context in which women live their lives.

AIMS

The aim of this study was to explore the lived experiences of maternal obesity and delve into how experiences of the body and motherhood affect women's motivation for participating in a postpartum lifestyle intervention.

METHOD

A qualitative study using in-depth semi-structured interviews based on participant-generated photographs was used to allow the women to openly express their lived experiences of maternal obesity. The study emanated from a gynaecological department of a major Danish hospital, and five pregnant or postpartum women living with obesity participated. Interviews were audio recorded, transcribed and analysed using an Interpretive Phenomenological Approach.

RESULTS

The analysis identified an overall theme of ambivalence and four subthemes among the participating women. The themes reflected contrasting feelings where the obese body was simultaneously an arena for aesthetic failure, functional success and moral dilemmas. Experiences of weight stigma and moral accusations in healthcare settings further increased the women's sense of ambivalence and challenged their strong desire to lose weight.

CONCLUSION

This study highlights an ambivalent and vulnerable situation of maternal obesity which makes moral sensitivity towards weight and body concerns crucial to consider in future maternal health interventions. Our data suggest that an emphasis on functionality and capability rather than aesthetics and measured ideals would be useful in providing care and support in postpartum lifestyle interventions for women living with obesity.

Parental substance and alcohol abuse: Two ethical frameworks to assess whether and how intervention is appropriate

Ethical frameworks can support professionals' decision-making. Here, we identify two ethical frameworks to analyse the best support for families that struggle with parental substance or alcohol abuse. The first framework, which we call 'the framework of conflicting interests', is most prominent in the literature. Here, the interests of parents and children are weighed against each other using the medical ethical principles of respect for autonomy, justice, beneficence, and non-maleficence. The second framework is most prominent in a series of interviews we conducted with alcohol-dependent parents and professionals working in addiction care and youth care. This framework aligns more with an ethics of care, and starts with the assumption that the interests of people who are close to each other are often intertwined. This framework does not so much look at conflicting interests, but at relationships and vulnerability. We label this the ethics of care framework. In this article, we show the value of both frameworks and how they can support ethical decision-making.

Social decision making in severe alcohol use disorder: Scoping review and experimental perspectives

BACKGROUND

Patients with severe alcohol use disorder (SAUD) demonstrate multifaceted impairments in social cognition abilities, including emotional decoding or Theory of Mind. Such impairments are associated with real-life interpersonal difficulties, which in turn could contribute to the persistence of SAUD. However, little is known regarding how patients with SAUD make decisions in a social context and this literature has not been comprehensively reviewed.

OBJECTIVES

The main aim of this paper was to conduct the first review specifically focusing on social decision-making abilities in SAUD. Following PRISMA guidelines for scoping reviews, we describe existing knowledge regarding the difficulties experienced by patients with SAUD during social interactions. Our second objective was to propose perspectives for future research, based on the shortcomings identified in the available literature.

DESIGN

We searched three online databases (PubMed, PsycINFO, and Scopus) and identified 14 papers using behavioral tasks to assess social decision making in patients with SAUD.

RESULTS

Included studies assessed social decision making through three paradigms: (1) economic games (four papers), (2) moral dilemmas (four papers), and (3) interpersonal problem-solving (six papers). Results indicated that patients with SAUD behave differently from controls in all three paradigms.

CONCLUSIONS

Previous studies suggested large-scale social decision-making impairments or biases in SAUD. However, in light of the limited number of studies available and of the restricted set of processes measured, we call for the extension of this field through more ecologically relevant and model-based paradigms in order to elucidate the underlying mechanisms of these effects.

Principlism's Balancing Act: Why the Principles of Biomedical Ethics Need a Theory of the Good

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification-adding specific content to general principles-and balancing-determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it lacks a theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework.

How Self-Control Predicts Moral Decision Making: An Exploratory Study on Healthy Participants

Research on moral reasoning calls into question self-control, which encompasses impulsivity, compulsivity, and inhibitory control. However, a thorough investigation exploring how these three dimensions can affect moral reasoning in response to different scenarios is unavailable. We addressed this topic by testing the predictive role of these three dimensions of self-control on appraisals for ethical violations related with different types of scenarios. Overall, our results suggest that all three dimensions of self-control are involved in moral reasoning, depending on the type of appraisal and provided moral scenarios.

"I Had No Idea That Other People in the World Thought Differently to Me": Ethical Challenges in Small Animal Veterinary Practice and Implications for Ethics Support and Education

Although veterinarians encounter ethical challenges in their everyday practice, few studies have examined how they make sense of and respond to them. This research used semi-structured interviews and a qualitative methodology (phenomenological and constructivist/interpretivist approaches) to explore ethical challenges experienced by seven small animal city veterinarians and their ethical decision-making strategies. Thematic analysis of the interview transcripts identified four broad ethical issues: The first concerned disagreements about the best interests of the animal; the second centered on clinical uncertainty about the most appropriate treatment for the animal; the third involved factors influencing ethical reasoning and decision making; and the fourth concerned how ethics education might prepare veterinary students for future ethical decision making. An overarching theme identified in the analysis was one of enormous personal distress. Furthermore, a sense of veterinarians being interested in how others might think and feel about ethical challenges came through in the data. The results give insight into how veterinarians experience and respond to ethical challenges. The research also provides empirical information about everyday practice to inform future education in ethics and ethical decision making for veterinary students.

Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study

On March 9, 2020, Italy has gone into "lockdown" because of COVID-19 pandemic, with a national quarantine. All non-essential working activities and schools of all levels have been temporarily closed: consequently, the entire population have been forced to dramatically change their daily habits. The pandemic raised important psychological, moral, social, and economic issues. Our research focused on the moral decision-making of people during an emergency. This paper reports two studies. The aim of Study 1 was to evaluate moral decision-making, level of perceived stress, ability of mentalizing and empathy in university students and Italian workers. 224 front-line workers (FLW), 413 second-line workers (SLW), and 663 university students (US), during Italian Phase 1 of lockdown, completed an online questionnaire. The results of Study 1 showed that participants in the FLW group are more likely to choose utilitarian solutions and judge as morally acceptable actions finalized to saving lives of more people if this requires sacrificing a low number of individuals. At the same time, decision-making was experienced as less unpleasant and less arousing with respect to the other two groups, demonstrating a greater ability to keep emotional control under pressure. In Study 2, we compared the same variables used in Study 1, selecting two professional categories from the FLW group engaged in emergency during COVID-19, namely healthcare providers (n = 82) and public safety personnel (n = 117). Our results showed that healthcare providers were more stressed and emotionally involved than public safety personnel, with higher empathic concern and arousal in moral decision-making. We suggest it is essential providing immediate psychological support and monitoring physical and emotional well-being for workers in the front-line during emergencies like the COVID-19 pandemic, in order to prevent experiences of moral distress or mental health problems.

Would You Sacrifice Yourself to Save Five Lives? Processing a Foreign Language Increases the Odds of Self-Sacrifice in Moral Dilemmas

Foreign languages blunt emotional reactions to moral dilemmas. In this study, we aimed at clarifying whether this reduced emotional response applies to the emotions related to the self, empathy, or both. Participants were presented with moral dilemmas, written in their native or foreign language, in which they could sacrifice one man or themselves in order to save five lives (or do nothing and therefore leave five people to die). They were more willing to sacrifice themselves when processing the dilemmas in their foreign language. Also, empathy scores were reduced when responding in the foreign language, but were no reliable predictors of participants' responses to the dilemmas. These results suggest that processing a foreign language reduces emotional reactivity due to psychological and emotional self-distance.

The moral residue of conservation

Should conservationists use lethal management to control introduced wildlife populations? Should they kill individual animals to protect endangered species? Are trade-offs that prioritize some values at the expense of others morally appropriate? These sorts of ethical questions are common in conservation. In debating such questions, conservationists often seem to presume 1 of 2 possible answers: the act in question is right or it is wrong. But morality in conservation is considerably more complex than this simple binary suggests. A robust conservation ethic requires a vocabulary that gives voice to the uncertainty and unease that arise when what seems to be the best available course of action also seems to involve a measure of wrongdoing. The philosophical literature on moral residue and moral dilemmas supplies this vocabulary. Moral dilemmas arise when one must neglect certain moral requirements to fulfill others. Under such circumstances, even the best possible decision leaves a moral residue, which is experienced emotionally as some form of grief. Examples of conservation scenarios that leave a moral residue include management of introduced rabbits in Australia, trophy hunting in Africa, and forest management trade-offs in the Pacific Northwest. Moral residue is integral to the moral experience of conservationists today, and grief is an appropriate response to many decisions conservationists must make. Article impact statement: Defensible conservation decisions may neglect moral requirements, leaving a moral residue; conservationists should respond with grief.

Hunger Bias or Gut Instinct? Responses to Judgments of Harm Depending on Visceral State Versus Intuitive Decision-Making

Empirical investigation into the emotional and physiological processes that shape moral decision-making is vast and growing. Yet, relatively less attention has been paid to measures of interoception in morality research despite its centrality in both emotional and physiological processes. Hunger and thirst represent two everyday interoceptive states, and hunger, in particular, has been shown to be influential for moral decision-making in numerous studies. It is possible that a tendency to focus on internal sensations interoceptive sensibility (IS), as well as the emotional and physiological states associated with visceral states, could be important in the relationships between hunger, thirst, and moral judgments. This cross-sectional online research (n = 154) explored whether IS, hunger, thirst, and emotional state influenced appropriateness and acceptability judgments of harm. The moral dilemma stimuli used allowed the independent calculation of (1) people's tendency to avoid harmful action at all costs and (2) people's tendency to maximize outcomes that benefit the greater good. The Cognitive Reflection Task (CRT) was implemented to determine whether an ability to override intuitive responses to counterintuitive problems predicted harm-based moral judgments, as found previously. Hunger bias, independent of IS and emotional state, was influential for non-profitable acceptability judgments of harmful actions. Contrary to dual-process perspectives, a novel finding was that more intuitive responses on the CRT predicted a reduced aversion to harmful actions that was indirectly associated with IS. We suggest that IS may indicate people's vulnerability to cognitive miserliness on the CRT task and reduced deliberation of moral dilemma stimuli. The framing of moral dilemmatic questions to encourage allocentric (acceptability questions) versus egocentric perspectives (appropriateness questions) could explain the divergence between hunger bias and intuitive decision-making for predicting these judgments, respectively. The findings are discussed in relation to dual-process accounts of harm-based moral judgments and evidence linking visceral experiences to harm aversion and moral decision-making.

Effects of Instrumentality and Personal Force on Deontological and Utilitarian Inclinations in Harm-Related Moral Dilemmas

Moral dilemmas often concern actions that involve causing harm to others in the attempt to prevent greater harm. But not all actions of this kind are equal in terms of their moral evaluation. In particular, a harm-causing preventive action is typically regarded as less acceptable if the harm is a means to achieve the goal of preventing greater harm than if it is a foreseen but unintended side-effect of the action. Likewise, a harm-causing preventive action is typically deemed less acceptable if it directly produces the harm than if it merely initiates a process that brings about the harmful consequence by its own dynamics. We report three experiments that investigated to which degree these two variables, the instrumentality of the harm (harm as means vs. side-effect; Experiments 1, 2, and 3) and personal force (personal vs. impersonal dilemmas; Experiments 2 and 3) influence deontological (harm-rejection) and utilitarian (outcome-maximization) inclinations that have been hypothesized to underly moral judgments in harm-related moral dilemmas. To measure these moral inclinations, the process dissociation procedure was used. The results suggest that the instrumentality of the harm and personal force affect both inclinations, but in opposite ways. Personal dilemmas and dilemmas characterized by harm as a means evoked higher deontological tendencies and lower utilitarian tendencies, than impersonal dilemmas and dilemmas where the harm was a side-effect. These distinct influences of the two dilemma conceptualization variables went undetected if the conventional measure of moral inclinations, the proportion of harm-accepting judgments, was analyzed. Furthermore, although deontological and utilitarian inclinations were found to be largely independent overall, there was some evidence that their correlation depended on the experimental conditions.

A genetic profile of oxytocin receptor improves moral acceptability of outcome-maximizing harm in male insurance brokers

In recent years, conflicting findings have been reported in the scientific literature about the influence of dopaminergic, serotonergic and oxytocinergic gene variants on moral behavior. Here, we utilized a moral judgment paradigm to test the potential effects on moral choices of three polymorphisms of the Oxytocin receptor (OXTR): rs53576, rs2268498 and rs1042770. We analyzed the influence of each single polymorphism and of genetic profiles obtained by different combinations of their genotypes in a sample of male insurance brokers (n = 129), as compared to control males (n = 109). Insurance brokers resulted significantly more oriented to maximize outcomes than control males, thus they expressed more than controls the utilitarian attitude phenotype. When analyzed individually, none of the selected variants influenced the responses to moral dilemmas. In contrast, a composite genetic profile that potentially increases OXTR activity was associated with higher moral acceptability in brokers. We hypothesize that this genetic profile promotes outcome-maximizing behavior in brokers by focusing their attention on what represents a greater good, that is, saving the highest number of people, even though at the cost of sacrificing one individual. Our data suggest that investigations in a sample that most expresses the phenotype of interest, combined with the analysis of composite genetic profiles rather than individual variants, represent a promising strategy to find out weak genetic influences on complex phenotypes, such as moral behavior.

Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum

BACKGROUND

Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant.

OBJECTIVE

The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency.

RESEARCH DESIGN

The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies.

ETHICAL CONSIDERATIONS

No significant ethical considerations as this is a discussion paper.

FINDINGS

The model was structured from the anthropology's concepts and decision-making process, applied to real situations. The structure of the three domains theoretical-practical-communicative is present in each session.

DISCUSSION

It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students' resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied.

CONCLUSION

We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.

(How) Do You Regret Killing One to Save Five? Affective and Cognitive Regret Differ After Utilitarian and Deontological Decisions

Sacrificial moral dilemmas, in which opting to kill one person will save multiple others, are definitionally suboptimal: Someone dies either way. Decision-makers, then, may experience regret about these decisions. Past research distinguishes affective regret, negative feelings about a decision, from cognitive regret, thoughts about how a decision might have gone differently. Classic dual-process models of moral judgment suggest that affective processing drives characteristically deontological decisions to reject outcome-maximizing harm, whereas cognitive deliberation drives characteristically utilitarian decisions to endorse outcome-maximizing harm. Consistent with this model, we found that people who made or imagined making sacrificial utilitarian judgments reliably expressed relatively more affective regret and sometimes expressed relatively less cognitive regret than those who made or imagined making deontological dilemma judgments. In other words, people who endorsed causing harm to save lives generally felt more distressed about their decision, yet less inclined to change it, than people who rejected outcome-maximizing harm.

Development of Experimental Materials on Moral Judgment in Sport: Evidence From Chinese Athletes

Objectives: The existing scales for moral judgment in sport have some limitations when used for cognitive neural research. Developing a set of experimental materials with good validity is thus warranted. The purpose of this study was to develop experimental materials that can be used in cognitive neuroscience research on moral judgment in sport.

Design: Study 1 was a qualitative study and Study 2 used a within-subject design.

Method: In Study 1, a qualitative method was adopted to assess types of moral misconduct among Chinese athletes, based on news reports of Chinese athletes' moral misconduct collected from the Internet and from interviews with Chinese elite athletes. In Study 2, typical examples were selected from a qualitative analysis based on the types of moral misconduct observed among athletes in Study 1. The examples were then compiled, controlled, and modified. The validity of the developed experimental materials was evaluated.

Results: The moral misconduct observed in Chinese athletes can be divided into the following four categories: violent behavior, doping, match-fixing or tanking, and self-reported dishonesty. Subject analysis and item analysis consistently found that the experimental materials developed for moral judgment based on the four categories were significantly different in six aspects, including the rate of participants' agreement to the proposed resolution [F_{Subject(3, 184)} = 236.60, p = 0.00; F_{Item(3, 156)} = 471.17, p = 0.00], decision time [F_{Subject(3, 184)} = 23.69, p = 0.00; F_{Item(3, 156)} = 3.13, p = 0.03], moral conflict [F_{Subject(3, 184)} = 3.70, p = 0.01; F_{Item(3, 156)} = 10.71, p = 0.00], moral acceptability of the behavior [F_{Subject(3, 184)} = 58.22, p = 0.00; F_{Item(3, 156)} = 110.69, p = 0.00], emotional valence [F_{Subject(3, 184)} = 3.41, p = 0.02; F_{Item(3, 156)} = 3.11, p = 0.03], and emotional arousal [F_{Subject(3, 184)} = 1.32, p = 0.27; F_{Item(3, 156)} = 5.09, p = 0.00]. The experimental materials developed were not affected by the type of sport.

Conclusions: The developed experimental materials can be used as experimental materials for cognitive neuroscience research on moral judgment in sport.

Moral Judgements on the Actions of Self-Driving Cars and Human Drivers in Dilemma Situations From Different Perspectives

Self-driving cars have the potential to greatly improve public safety. However, their introduction onto public roads must overcome both ethical and technical challenges. To further understand the ethical issues of introducing self-driving cars, we conducted two moral judgement studies investigating potential differences in the moral norms applied to human drivers and self-driving cars. In the experiments, participants made judgements on a series of dilemma situations involving human drivers or self-driving cars. We manipulated which perspective situations were presented from in order to ascertain the effect of perspective on moral judgements. Two main findings were apparent from the results of the experiments. First, human drivers and self-driving cars were largely judged similarly. However, there was a stronger tendency to prefer self-driving cars to act in ways to minimize harm, compared to human drivers. Second, there was an indication that perspective influences judgements in some situations. Specifically, when considering situations from the perspective of a pedestrian, people preferred actions that would endanger car occupants instead of themselves. However, they did not show such a self-preservation tendency when the alternative was to endanger other pedestrians to save themselves. This effect was more prevalent for judgements on human drivers than self-driving cars. Overall, the results extend and agree with previous research, again contradicting existing ethical guidelines for self-driving car decision making and highlighting the difficulties with adapting public opinion to decision making algorithms.

Perceptions of attending medical staff by women accessing pregnancy termination in Poland: a qualitative study

OBJECTIVES

Polish society is strongly influenced by the Catholic Church and Poland has one of the most restrictive abortion laws in Europe. We attempted to gather information by questionnaire from women considering termination of pregnancy (TOP). Women were asked about their perceptions of the attending medical staff and whether they felt they had been fully informed of their rights, as well as about conduct of the procedure itself in light of physicians' use of the 'conscience clause'.

METHODS

Between June 2014 and May 2016 all women deemed eligible for TOP for medical reasons were asked to complete an anonymous questionnaire (n = 240). A total of 150 questionnaires (62.5%) were returned and analysed.

RESULTS

Most respondents (95%) lived in a town or city, and a significant number (40%) lived outside the area where the study centre was located. The main reason for such a large group of out-of-region respondents (53%) was the lack of centres offering TOP in the area where the women lived. Only one attending obstetrician did not support a decision to abort the pregnancy. Although 65% of treating physicians supported the woman's decision, only 8% were willing to perform the procedure themselves.

CONCLUSION

Most regional centres offer no access to TOP, despite the legal right of women to abort their pregnancy in the event of a severe fetal defect. Some physicians refuse to perform abortions, citing conscientious objection. Double standards among treating physicians have been detected, as many support the decision of their patient but refuse to perform the procedure themselves.

The contribution of brain imaging to the understanding of psychopathy

Psychopathy is a personality type characterized by both callous emotional dysfunction and deviant behavior that affects society in the form of actions that harm others. Historically, researchers have been concerned with seeking data and arguments to support a neurobiological foundation of psychopathy. In the past few years, increasing research has begun to reveal brain alterations putatively underlying the enigmatic psychopathic personality. In this review, we describe the brain anatomical and functional features that characterize psychopathy from a synthesis of available neuroimaging research and discuss how such brain anomalies may account for psychopathic behavior. The results are consistent in showing anatomical alterations involving primarily a ventral system connecting the anterior temporal lobe to anterior and ventral frontal areas, and a dorsal system connecting the medial frontal lobe to the posterior cingulate cortex/precuneus complex and, in turn, to medial structures of the temporal lobe. Functional imaging data indicate that relevant emotional flow breakdown may occur in both these brain systems and suggest specific mechanisms via which emotion is anomalously integrated into cognition in psychopathic individuals during moral challenge. Directions for future research are delineated emphasizing, for instance, the relevance of further establishing the contribution of early life stress to a learned blockage of emotional self-exposure, and the potential role of androgenic hormones in the development of cortical anomalies.

Moral dilemmas reflect professional core values of pharmacists in community pharmacy

Objectives

The aim was to recognise the professional core values in the moral dilemmas of pharmacists in community pharmacy and to customise the descriptions of these values for community pharmacy practice.

Methods

The narratives of 128 moral dilemmas, collected from Dutch PharmD students and early career pharmacists who experienced these dilemmas in practice, were qualitatively analysed. An expert panel deductively coded relevant portions of these narratives with the core values as formulated by the Royal Dutch Pharmacists Association. Other values that emerged were inductively coded and if possible used to further customise the respective core values.

Key findings

The expert panel identified all four professional core values, that is, commitment to the patient's well‐being (117, 91.4%), reliable and caring (116, 90.6%), pharmaceutical expertise (72, 56.2%) and responsibility to society (30, 23.4%) in the 128 moral dilemma narratives. Thirteen other values that emerged in the analysis could all be used for the customisation of the professional core values in descriptions that better reflect community pharmacy practice.

Conclusions

Professional core values were identified in moral dilemma narratives of pharmacists in community pharmacy and customised for their practice. These customised core values can enable pharmacists to better recognise moral dilemmas in practice. This can add to the advancement of the profession as a pharmaceutical care practice.

Moral Judgement in Early Bilinguals: Language Dominance Influences Responses to Moral Dilemmas

The Foreign-Language effect (FLe) on morality describes how late bilinguals make different decisions on moral judgements, when presented in either their native or foreign language. However the relevance of this phenomenon to early bilinguals, where a language's “nativeness” is less distinct, is unknown. This study aims to verify the effect of early bilinguals' languages on their moral decisions and examine how language experience may influence these decisions. Eighty-six early English-Chinese bilinguals were asked to perform a moral dilemmas task consisting of personal and impersonal dilemmas, in either English or Mandarin Chinese. Information on language experience factors were also collected from the participants. Findings suggest that early bilinguals do show evidence of a language effect on their moral decisions, which is dependent on how dominant they are in the language. Particularly, the more dominant participants were in their tested language, the larger the difference between their personal and impersonal dilemma response choice. In light of these findings, the study discusses the need to re-examine how we conceptualize the FLe phenomenon and its implications on bilinguals' moral judgement. It also addresses the importance of treating bilingualism as multidimensional, rather than a unitary variable.

Beyond sacrificial harm: A two-dimensional model of utilitarian psychology

[Correction Notice: An Erratum for this article was reported in Vol 125(2) of Psychological Review (see record 2018-15704-001). The copyright attribution was incorrectly listed, and the Creative Commons CC-BY license disclaimer was incorrectly omitted from the author note. The correct copyright is "© 2017 The Author(s)" and the omitted disclaimer is found in the erratum. All versions of this article have been corrected.] Recent research has relied on trolley-type sacrificial moral dilemmas to study utilitarian versus nonutilitarian modes of moral decision-making. This research has generated important insights into people's attitudes toward instrumental harm-that is, the sacrifice of an individual to save a greater number. But this approach also has serious limitations. Most notably, it ignores the positive, altruistic core of utilitarianism, which is characterized by impartial concern for the well-being of everyone, whether near or far. Here, we develop, refine, and validate a new scale-the Oxford Utilitarianism Scale-to dissociate individual differences in the 'negative' (permissive attitude toward instrumental harm) and 'positive' (impartial concern for the greater good) dimensions of utilitarian thinking as manifested in the general population. We show that these are two independent dimensions of proto-utilitarian tendencies in the lay population, each exhibiting a distinct psychological profile. Empathic concern, identification with the whole of humanity, and concern for future generations were positively associated with impartial beneficence but negatively associated with instrumental harm; and although instrumental harm was associated with subclinical psychopathy, impartial beneficence was associated with higher religiosity. Importantly, although these two dimensions were independent in the lay population, they were closely associated in a sample of moral philosophers. Acknowledging this dissociation between the instrumental harm and impartial beneficence components of utilitarian thinking in ordinary people can clarify existing debates about the nature of moral psychology and its relation to moral philosophy as well as generate fruitful avenues for further research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Deontological Dilemma Response Tendencies and Sensorimotor Representations of Harm to Others

The dual process model of moral decision-making suggests that decisions to reject causing harm on moral dilemmas (where causing harm saves lives) reflect concern for others. Recently, some theorists have suggested such decisions actually reflect self-focused concern about causing harm, rather than witnessing others suffering. We examined brain activity while participants witnessed needles pierce another person's hand, versus similar non-painful stimuli. More than a month later, participants completed moral dilemmas where causing harm either did or did not maximize outcomes. We employed process dissociation to independently assess harm-rejection (deontological) and outcome-maximization (utilitarian) response tendencies. Activity in the posterior inferior frontal cortex (pIFC) while participants witnessed others in pain predicted deontological, but not utilitarian, response tendencies. Previous brain stimulation studies have shown that the pIFC seems crucial for sensorimotor representations of observed harm. Hence, these findings suggest that deontological response tendencies reflect genuine other-oriented concern grounded in sensorimotor representations of harm.

It's immoral, but I'd do it! Psychopathy traits affect decision-making in sacrificial dilemmas and in everyday moral situations

This research investigated whether emotional hyporeactivity affects moral judgements and choices of action in sacrificial moral dilemmas and in everyday moral conflict situations in which harm to other's welfare is differentially involved. Twenty-six participants with high trait psychopathy (HP) and 25 with low trait psychopathy (LP) were selected based on the primary psychopathy scale of the Levenson Self-Report Psychopathy Scale. HP participants were more likely to sacrifice one person to save others in sacrificial dilemmas and to pursue a personal advantage in everyday moral situations entailing harm to another's good. While deciding in these situations, HP participants experienced lower unpleasantness as compared to LP participants. Conversely, no group differences emerged in choice of action and unpleasantness ratings for everyday moral situations that did not entail harm to others. Importantly, moral judgements did not differ in the two groups. These results suggest that high psychopathy trait affects choices of action in sacrificial dilemmas because of reduced emotional reactivity to harmful acts. The dissociation between choice of action and moral judgement suggests that the former is more closely related to emotional experience. Also, emotion seems to play a critical role in discriminating harmful from harmless acts and in driving decisions accordingly.

Moral Dilemmas and Existential Issues Encountered Both in Psychotherapy and Philosophical Counseling Practices

This paper stems from clinical observations and empirical data collected in the therapy room over six years. It investigates the relationship between psychotherapy and philosophical counseling, proposing an integrative model of counseling. During cognitive behavior therapy sessions with clients who turn to therapy in order to solve their clinical issues, the author noticed that behind most of the invalidating symptoms classified by the DSM-5 as depression, anxiety, hypochondriac and phobic complaints, usually lies a lack of existential meaning or existential scope and clients are also tormented by moral dilemmas. Following the anamnestic interview and the psychological evaluation, rarely the depression or anxiety diagnosed on Axis I is purely just a sum of invalidating symptoms, which may disappear if treated symptomatically. When applying the Sentence Completion Test, an 80 items test of psychodynamic origin and high-face validity, most of the clients report an entire plethora of conscious or unconscious motivations, distorted cognitions or irrational thinking but also grave existential themes such as scope or meaning of life, professional identity, fear of death, solitude and loneliness, freedom of choice and liberty. Same issues are approached in the philosophical counseling practice, but no systematic research has been done yet in the field. Future research and investigation is needed in order to assess the importance of moral dilemmas and existential issues in both practices.

Behavioral and autonomic reactivity to moral dilemmas in frontotemporal dementia versus Alzheimer's disease

The personal/impersonal distinction of moral decision-making postulates intuitive emotional responses from medial frontal activity and rational evaluation from lateral frontal activity. This model can be analyzed in behavioral variant frontotemporal dementia (bvFTD), a disorder characterized by impaired emotional intuitions, ventromedial prefrontal cortex (vmPFC) involvement, and relative sparing of lateral frontal regions. Moral dilemmas were presented to 10 bvFTD, 11 Alzheimer's disease (AD), and 9 healthy control (HC) participants while recording skin conductance responses, a measure of emotional arousal. We evaluated their personal versus impersonal conflict, subjective discomfort, and adherence to social norms. Replicating prior work, bvFTD participants were more willing to harm in the personal, but not the impersonal, dilemma compared to AD and HC groups. BvFTD participants had lower arousal and less of an increase in conflict on the personal versus the impersonal dilemma, in contrast to increased arousal and conflict for the AD and HC groups. Furthermore, bvFTD participants verbalized less discomfort, a correlate of low adherence to social norms. These findings support impaired emotional reactions to moral dilemmas in bvFTD and vmPFC lesions and the personal/impersonal model. It suggests a reversion to utilitarian-like considerations when emotional intuition is impaired in the brain.

Gender differences in responses to moral dilemmas: a process dissociation analysis

The principle of deontology states that the morality of an action depends on its consistency with moral norms; the principle of utilitarianism implies that the morality of an action depends on its consequences. Previous research suggests that deontological judgments are shaped by affective processes, whereas utilitarian judgments are guided by cognitive processes. The current research used process dissociation (PD) to independently assess deontological and utilitarian inclinations in women and men. A meta-analytic re-analysis of 40 studies with 6,100 participants indicated that men showed a stronger preference for utilitarian over deontological judgments than women when the two principles implied conflicting decisions (d = 0.52). PD further revealed that women exhibited stronger deontological inclinations than men (d = 0.57), while men exhibited only slightly stronger utilitarian inclinations than women (d = 0.10). The findings suggest that gender differences in moral dilemma judgments are due to differences in affective responses to harm rather than cognitive evaluations of outcomes.

Moral dilemmas in females: children are more utilitarian than adults

Influential theories on moral judgments propose that they rely either on emotions or on innate moral principles. In contrast, the mental model theory postulates that moral judgments rely on reasoning, either intuition or deliberation. The theory allows for the possibility that intuitions lead to utilitarian judgments. This paper reports two experiments involving fifth-grade children, adolescents, and adults; the results revealed that children reason intuitively to resolve moral dilemmas in which action and inaction lead to different outcomes. In particular, the results showed female children to be more utilitarian than female adults in resolving classical moral dilemmas: they preferred an action that achieved a good outcome for a greater number of people. Within the mental model theory's framework there is no reason to expect that females and males differ in their ability to reason, but at the moment the results for females cannot be generalized to males who were not properly represented in the adults groups of the two experiments. The result revealing that (female) children are more utilitarian than (female) adults, which is hard to explain via many current theories, was predicted by the mental model theory.

Cold-hearted or cool-headed: physical coldness promotes utilitarian moral judgment

In the current study, we examine the effect of physical coldness on personal moral dilemma judgment. Previous studies have indicated that utilitarian moral judgment—sacrificing a few people to achieve the greater good for others—was facilitated when: (1) participants suppressed an initial emotional response and deliberately thought about the utility of outcomes; (2) participants had a high-level construal mindset and focused on abstract goals (e.g., save many); or (3) there was a decreasing emotional response to sacrificing a few. In two experiments, we exposed participants to extreme cold or typical room temperature and then asked them to make personal moral dilemma judgments. The results of Experiment 1 indicated that coldness prompted utilitarian judgment, but the effect of coldness was independent from deliberate thought or abstract high-level construal mindset. As Experiment 2 revealed, coldness facilitated utilitarian judgment via reduced empathic feelings. Therefore, physical coldness did not affect the “cool-headed” deliberate process or the abstract high-level construal mindset. Rather, coldness biased people toward being “cold-hearted,” reduced empathetic concern, and facilitated utilitarian moral judgments.

Moral judgment reloaded: a moral dilemma validation study

We propose a revised set of moral dilemmas for studies on moral judgment. We selected a total of 46 moral dilemmas available in the literature and fine-tuned them in terms of four conceptual factors (Personal Force, Benefit Recipient, Evitability, and Intention) and methodological aspects of the dilemma formulation (word count, expression style, question formats) that have been shown to influence moral judgment. Second, we obtained normative codings of arousal and valence for each dilemma showing that emotional arousal in response to moral dilemmas depends crucially on the factors Personal Force, Benefit Recipient, and Intentionality. Third, we validated the dilemma set confirming that people's moral judgment is sensitive to all four conceptual factors, and to their interactions. Results are discussed in the context of this field of research, outlining also the relevance of our RT effects for the Dual Process account of moral judgment. Finally, we suggest tentative theoretical avenues for future testing, particularly stressing the importance of the factor Intentionality in moral judgment. Additionally, due to the importance of cross-cultural studies in the quest for universals in human moral cognition, we provide the new set dilemmas in six languages (English, French, German, Spanish, Catalan, and Danish). The norming values provided here refer to the Spanish dilemma set.

Functional alteration in frontolimbic systems relevant to moral judgment in cocaine-dependent subjects

Cocaine addiction is characterized by persistent decision-making deficits, which are linked to structural and functional abnormalities in frontolimbic systems. Moral judgment is as a special instance of decision making, in which both cognitive and emotional signals must be adequately integrated to decide how to resolve moral dilemmas. Here, we employed a moral dilemmas functional magnetic resonance imaging (fMRI) task to explore possible alterations of frontolimbic systems in cocaine-dependent subjects. We also explored if these alterations relate to more basic deficits in functional connectivity within these systems during spontaneous resting-state activation. Ten cocaine-dependent subjects and 14 non-drug-using controls participated in the study. Cocaine-dependent subjects were carefully selected to discard potentially confounding co-morbidities, and they underwent a uniform supervised abstinence period of 10 days. Both groups were scanned, and fMRI maps were generated to identify (1) brain response to moral dilemmas; and (2) the strength of functional connectivity within frontolimbic systems during resting-state. During the moral dilemmas task, cocaine-dependent subjects showed reduced activation involving frontolimbic structures as the anterior cingulate cortex (ACC), left insula and brain stem. Connectivity analyses showed that cocaine users had less resting-state functional connectivity between ACC, thalamus, insula and brain stem. These results demonstrate that cocaine-dependent subjects have functional alterations in the frontolimbic systems that support moral judgment and social decision making.

Roman Catholic beliefs produce characteristic neural responses to moral dilemmas

This study provides exploratory evidence about how behavioral and neural responses to standard moral dilemmas are influenced by religious belief. Eleven Catholics and 13 Atheists (all female) judged 48 moral dilemmas. Differential neural activity between the two groups was found in precuneus and in prefrontal, frontal and temporal regions. Furthermore, a double dissociation showed that Catholics recruited different areas for deontological (precuneus; temporoparietal junction) and utilitarian moral judgments [dorsolateral prefrontal cortex (DLPFC); temporal poles], whereas Atheists did not (superior parietal gyrus for both types of judgment). Finally, we tested how both groups responded to personal and impersonal moral dilemmas: Catholics showed enhanced activity in DLPFC and posterior cingulate cortex during utilitarian moral judgments to impersonal moral dilemmas and enhanced responses in anterior cingulate cortex and superior temporal sulcus during deontological moral judgments to personal moral dilemmas. Our results indicate that moral judgment can be influenced by an acquired set of norms and conventions transmitted through religious indoctrination and practice. Catholic individuals may hold enhanced awareness of the incommensurability between two unequivocal doctrines of the Catholic belief set, triggered explicitly in a moral dilemma: help and care in all circumstances-but thou shalt not kill.